How PTs Can End the Opioid Epidemic

The opioid epidemic is a true crisis in health care. Instead of helping patients, profit-driven or careless pharmaceutical companies, hospital networks, and providers have caused irreparable harm. In 2017 alone, 72,000 people died from an opioid overdose. Furthermore, of all the patients who receive prescription painkillers on a long-term basis for noncancer pain in a primary care setting, one in four end up struggling with addiction. And those who are addicted to prescription opioids are 40 times more likely to develop an addiction to heroin. In other words, patients who receive unnecessary prescriptions for pain medication are on an incredibly slippery slope that bottoms out fast.

Several lawsuits have brought the epidemic front and center—yet again.

A host of recently filed lawsuits have brought the epidemic front and center yet again, including a huge one against Purdue Pharma alleging that members of the Sackler family (who own the company) knowingly put patients at risk by pushing high-dose prescriptions for OxyContin—and then, on top of that, attempted to profit off their addiction treatment. According to court documents, Richard Sackler—the former president of the company—“personally directed sales representatives [via email] to push doctors to prescribe extremely high doses of opioids.” It’s infuriating, I know.

These practices are dangerous for patients and expensive for payers.

While these types of practices are obviously extremely dangerous for patients, they’re also expensive for payers—especially when compared to safer, less invasive approaches to treating musculoskeletal pain (e.g., physical therapy). At last year’s Ascend Business Summit, David Elton, the Senior Vice President of Clinical Programs at Optum and a member of the UnitedHealth Group’s Opioid Task Force and Pain Management Work Group, shared some illuminating data, which we originally posted here: according to a soon-to-be-published study conducted by Boston University—and jointly sponsored by UHC and the APTA—“claims for musculoskeletal episodes accounted for more than 16% of total spending—a percentage greater than that associated with any other condition. Furthermore, 75% of that spending went toward prescription medications. To put that into perspective, a little over 11% of UHC’s total spend went toward claims for cancer treatment.” In other words, UHC—one of the nation’s largest health plans—is spending more money on prescription pain medication for musculoskeletal episodes than it is spending on cancer treatment.

Now’s our opportunity to get in front of patients who are suddenly more likely to question prescriptions for painkillers.

While it’s hard to see the upside when you consider how many patients have been hurt by this epidemic to date, there is a silver lining. With the amount of attention the opioid epidemic is currently receiving in our country, patients, payers, and policy makers are more open to, and eager for, alternative interventions. I’ve talked before about how this is our moment to seize the day and be part of the long-term solution to the opioid epidemic—thereby gaining large-scale visibility and helping more patients live pain-free, fully functional lives. And this unfolding lawsuit just adds to the timeliness of this opportunity. It really is now or never for us to get in front of patients who are suddenly more likely to question their physicians’ painkiller prescriptions—and payers who are actively looking for better, more cost-effective care paths for their beneficiaries. Here’s how:

1. Work together.

We won’t be able to effect the change we want in the world unless we let go of the silo mentality we’ve been operating under and instead unite behind a common message that supports the benefits of physical therapy on the whole (in addition to our individual practices). In other words, we all must be “in” for this to work (cue virtual hand stack).

2. Get loud.

Shout the benefits of what we do from the rooftops, get it covered in the media, and optimize your online marketing channels. In other words, do whatever you need to do to get the attention of all the stakeholders in this crisis: referring providers, payers, and patients themselves. The more people—and healthcare organizations—who demand a PT-first approach, the better and more supportive the clinical pathways and insurance plans will be.

3. Back everything up with data.

In addition to touting your own outcomes data on your website, in your marketing materials, and in your conversations with payers and referral sources, it’s time to start propagating the scholarly research that’s been done in support of physical therapy, because it’s growing. For example, this Stanford article discusses a 2018 study finding “that those who underwent physical therapy within three months of being diagnosed with pain in the shoulder, neck, low back or knee were approximately 7 to 16 percent less likely to use opioids in the subsequent months.” Every time there’s a new research article posted, I want to hear about it from the community. (On my end, I’ll continue to use my social media channels and blog to help spread the reach of the data we accumulate.)

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If we step up now and do this right—if we unite to effectively communicate the value of our services—then we may be able to end the opioid epidemic and finally reach the 90% of patients who could benefit from seeing a physical therapist but never do. Right now, we have the opportunity to accomplish in months what might otherwise take years or even decades to achieve. I’m in. Who’s with me? Who’s ready to act now?

About the Author

Heidi Jannenga, PT, DPT, ATC/L, is the president and co-founder of WebPT, the leading practice management solution for physical, occupational, and speech therapists. Heidi leads WebPT’s product vision, company culture, and branding efforts, while advocating for the physical therapy profession on a national scale. She co-founded WebPT after recognizing the need for a more sophisticated industry-specific EMR platform and has since guided the company through exponential growth, while garnering national recognition. Heidi brings with her more than 15 years of experience as a physical therapist and multi-clinic site director as well as a passion for healthcare innovation, entrepreneurship, and leadership.

An active member of the sports and private practice sections of the APTA, Heidi advocates for independent rehab therapy businesses, speaks as a subject-matter expert at industry conferences and events, and participates in local and national technology, entrepreneurship, and women-in-leadership seminars. In 2014, Heidi was appointed to the PT-PAC Board of Trustees. She also serves as a mentor to physical therapy students and local entrepreneurs and leverages her platform to promote the importance of diversity, company culture, and overall business acumen for private practice rehab therapy professionals.

Heidi was a collegiate basketball player at the University of California, Davis, and remains a lifelong fan of the Aggies. She graduated with a bachelor’s degree in biological sciences and exercise physiology, went on to earn her master’s degree in physical therapy at the Institute of Physical Therapy in St. Augustine, Florida, and obtained her doctorate of physical therapy through Evidence in Motion. When she’s not enjoying time with her daughter Ava, Heidi is perfecting her Spanish, practicing yoga, or hiking one of her favorite Phoenix trails.

2 responses to “How PTs Can End the Opioid Epidemic”

Heidi…
Thanks for your “call to arms” article. I appreciate your call. It caused some instant thought on my part, that may even be surprising to you.

1. This is not about us…at all. I’m not insinuating you said this, but reinforcing the idea that this must be focused on people…not professions…or companies…or drugs…or anything else. Looking to blame or claim shifts focus from the issue. This is about the person who, for one reason or another has become addicted/dependent on opioid medication because it simply was the best option available to them based on what they (um, and us also) had available to them. And, in addition to that, if we hold the position that they bear no responsibility and are victims in this we only reinforce the dependency. Even the client has to bear at least some responsibility for their position/predicament. This is foundational to active coping and recovery. Recovery is about the person…not the physical therapy industry. Shame on us if it’s anything else than that.
2. 7-16% reduction in Opioid use, really, is nothing to tout. I’m not touting this Stanford article…at all. In fact, I’m a little ashamed it’s only 7-16%. I’m not planning on telling anyone this information. Knowing what we know now about pain science and how rapidly this information is expanding on neuroplasticity and neurorecovery, 7-16% is essentially 0%. The nervous system is the most powerful system we know of. We’ve not even charted the end of its ability. It’s crazy superfluously beyond what we know! I could never ask someone to come to me because there’s a 7-16% chance I could help them…or there’s a 7-16% chance they might get off opioid medication. I’ve not closely reviewed this article. But the results are highly UN-interesting to me. And, it’s not what I see in the clinic either. If this is the best we have to offer, we’re doomed…for sure.
3. Research, inherently, is biased and does not reproduce living. I’m not saying we shouldn’t have it. Indeed, we should. But it’s only a good place (and not even that sometimes!) to start. It’s only one piece of a 1 million piece puzzle. Anything other than that perspective and we continue down the road of numbers meaning really much more than they should. In pain science, we emphasize that “what the MRI says is not the full story” and include emphasis that facts don’t always lead to Truth. Overly emphasizing what this research article or that research article says leads us directly into the “silo mentality” you’ve mentioned. We’ll never know as much as we should. This leads us to consider other options…if we’re truly interested in helping the client and pursuing the Truth about the matter. Ironically, having this position also helps our clients be more active in their own recovery. We all must be individually motivated on the pursuit of self-excellence, helping everyone we can as we move along.

I fear that the possible bluntness of this reply might be received not as it is intended. The spirit of it comes from a heart that says “WE NEED TO DO BETTER”. That attitude makes no room for “Me-ness” or “Us-ness” or “blame-ness”. It simply focuses the believer in becoming better the next moment than they are in the present one. I have much to learn. Maybe I could even learn something from reading an article that touts a 7-16% chance of this or that. But I’m not there yet.